(First Quarter 2009) · (First Quarter 2009) EMERGENCY NUTRITION ... Nutrition Survey Results Ethiopia, Jan - Mar 2009. ENCU ENCU March 31, 2009 Page 2 ... nutrition situation observed

QUARTERLY BULLETIN (First Quarter 2009)

EMERGENCY NUTRITION

ENCU March 31, 2009 Page 1

INSIDE

NUTRITION ASSESSMENTSTANDARD NUTRITION SURVEYSPage 1 QUALITY CHECKPage 2ENCU DATA BASESPage 9

EMERGENCY NUTRITION INTERVENTIONSNEW ADMISSIONS IN TFP SITESPage 10COVERAGE OF EMERGENCY INTERVENTIONS INHOTSPOT WOREDASPage 12SUPPLIESPage 12PERFORMANCE OF THERAPEUTIC FEEDINGPROGRAMMES (TFP) IN ETHIOPIA, JAN - MAR 2009 Page 13TARGETED SUPPLEMENTARY FOOD (TSF) Page 13EMERGENCY NUTRITION INTERVENTION CHALLENGESPage 14

ESTIMATED TFP BENEFICIARIES AS PARTOF THE JAN - JUN 2009 HUMANITARIANAPPEALPage 15

RETROSPECTIVE STUDY ON NON-ANTHRO-POMETRIC DATA BASED ON NUTRITIONSURVEYS CONDUCTED IN ETHIOPIA. (2000-2008)Page 15

WORKSHOP ON NUTRITION ASSESSMENTMETHODOLOGY IN PASTORALIST COMMU-NITIES IN EHTIOPIAPage 16

Emergency Nutrition Coordination UnitEarly Warning & Response Department

(Disaster Management & Food Security Sector)

ENCU/EWRDAddis AbabaTel. (011) 5 523556e-mail: [email protected]://www.dppc.gov.et

Survey Methodology: In the firstquarter of 2009, a total of 29 surveyswere conducted in five regions;

SNPPR (13), Amhara (4), Tigray (4),Oromia (7) and Beneshangul Gumuz(1). All the 29 surveys were conducted

1.1 STANDARD NUTRITION SURVEYS

1. NUTRITION ASSESSMENT

Figure 1: Nutrition Survey Results Ethiopia, Jan - Mar 2009

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based on revised interim national guide-line on emergency nutrition assessmentfor Ethiopia revised recently based onthe SMART methodology. Eight of the29 were emergency nutrition surveysaiming at providing baseline informationfor future monitoring of nutrition inter-ventions. These included surveys con-ducted in Amhara (3), all surveys inTigray and B/Gumuz. The remainingwere monitoring or end line surveysconducted in SNNPR and Oromiaregions following nutrition interventionsmost of which were initiated in 3rd and4th quarters as part of the emergencyresponse in the 2008 nutrition crisis. Aspart of quality control and standardizethe undertaking of nutrition surveys inthe country, all the surveys proposalswere technically reviewed by theEmergency Nutrition Coordination Unit(ENCU). A formal approval was provid-ed for those proposals that met the

One of the 29 survey reports was nottimely submitted to the ENCU. Thus,quality check was not complete. Theremaining 28 surveys were checked byENCU applying agreed quality check cri-teria on the surveys' raw data submittedby partners along with respective prelim-inary reports. Preliminary reports werealso reviewed to see if they were pre-pared following the recommendedreporting format, and whether conclu-sions, recommendations and classifica-tion of the nutrition situation were coher-ent and consistent with the anthropo-metric and contextual factors. 25 of the28 surveys were accepted and 3 wererejected because of poor data quality.Two of the three rejected surveys were

conducted in Oromia and one inSNNPR. The 25 data sets were normal-ly distributed, with a degree of kurtosisand skewness fell within acceptable lev-els of ± 1 - indicating normal distributionaround the mean. Standard deviationsof the seven surveys were well below1.2 SD units, implying that the qualitywas good. The summary results of thethree surveys with poor data quality arenot presented. Table 1 summarises dataquality check results of the 25 surveys.

Other criteria used for quality checks(digit preference, sex ratio, age distribu-tion among the study sample) were with-in acceptable limits. All the results wereendorsed by the ENCU/EWRD.

1.2 QUALITY CHECK

requirements.

Sample sizes for the under-five studypopulation ranged from 524 in Soro to878 in Bure woredas in SNNPR. 25 sur-veys were conducted within the admin-istrative boundaries and two were con-ducted in coffee and Enset livelihoodzones both in SNNPR. Anthropometricand mortality analyses were conductedusing Emergency NutritionAssessments (ENA) for SMART soft-ware (October 2007; June 2008 ver-sions). WHO anthropometric standarddefinitions were used to define case ofmalnutrition among under-five children.Point prevalence estimates were report-ed using NCHS references. Vitamin Asupplementation, measles coverage,morbidity, MUAC measurements andfood security information was analyzedby partners using other software likeEPI Info, Excel and SPSS.

1 Emergency Nutrition Assessment for Ethiopia, September 2008.2 Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva,

World Health Organization (WHO Technical Report Series, No. 854). 1995.

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Table 1: Survey data Quality Check Results

* Age bias**Sex bias.

Digit preference

Representativeness of the sample

Agency Woreda/ Livelihood Zone Weight Height

SD of WHZ

Skewness of WHZ

Kurtosis of WHZ

No. 0f WHZ flags (%)

Age group (months)

% Distribu- tion

Sex Ratio

WVE Kilte Awulalo NO No 0.809 0.090 0.074 0.0 6-29 30-59

47.4 52.6

1.0

WVE Sasi Tsaeda Amba

NO No 0.776 0.163 0.079 0.0 6-29 30-59

42.7 57.3

1.2**

WVE Atsbi Wonberta NO No 0.806 0.240 0.103 0.0 6-29 30-59

41.6 58.4

1.1

WVE Alamata NO No 0.842 -0.015 0.217 0.0 6-29 30-59

41.6 58.4

0.9

WVE Eferata NO No 0.888 0.049 0.285 0.0 6-29 30-59

31.0* 69.0

1.1

WVE Menz Gera NO No 0.807 0.065 0.304 0.0 6-29 30-59

36.7* 63.3

0.9

WVE Tenta NO No 0.861 -0.045 0.178 0.0 6-29 30-59

38.0* 62.0

1.0

CONCERN Ambassel NO No 0.816 -0.033 -0.180 0.0 6-29 30-59

44.2 55.8

1.0

GOAL Kuni NO No 0.845 -0.110 -0.236 0.0 6-29 30-59

51.0 49.0

1.0

GOAL Kombolcha NO No 0.811 0.039 -0.372 0.0 6-29 30-59

50.5 49.5

1.0

GOAL Kersa NO No 0.867 0.103 0.076 0.0 6-29 30-59

48.1 51.9

1.0

SCUK Kumruk NO No 0.861 -0.136 0.378 0.0 6-29 30-59

47.4 52.6

1.2**

ACF ELZ NO No 0.804 0.153 0.114 0.0 6-29 30-59

46.0 54.0

1.1

ACF CLZ NO No 0.831 0.155 0.011 0.0 6-29 30-59

42.3 57.7

1.0

GOAL Shebedino NO No 0.832 0.130 0.213 0.16 6-29 30-59

39.3 * 60.7

1.1

GOAL Arbaminch zuria NO No 0.800 0.053 0.226 0.0 6-29 30-59

45.8 54.2

1.0

Samaritan's Purse

K/Gamella NO No 0.835 0.159 0.275 0.0 6-29 30-59

44.7 55.3

1.1

Samaritan's Purse

Alaba Spec ial Woreda

NO No 0.832 -0.022 0.005 0.0 6-29 30-59

48.5 51.5

1.1

Samaritan's Purse

Sankura NO No 0.897 0.138 0.030 0.0

6-29 30-59

48.2 51.8

1.0

CONCERN Shashego NO No 0.847 0.349 0.216 0.0 6-29 30-59

44.5 55.5

1.0

CONCERN Soro NO No 0.845 0.233 0.770 0.19 6-29 30-59

47.9 52.1

0.9

GOAL Damote Gale NO No 0.823 0.080 -0.024 0.0 6-29 30-59

43.2 56.8

0.8

GOAL Damote Pulasa NO No 0.854 -0.022 0.361 0.0 6-29 30-59

46.4 53.6

1.0

GOAL Bule NO No 0.828 -0.097 -0.133 0.0 6-29 30-59

45.8 54.2

0.9

GOAL Gedeb NO No 0.939 -0.293 0.042 0.0 6-29 30-59

50.0 50.0

1.0

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Key survey findings Nutritional status: Since there was nodiscernible differences in the results interms of Global Acute Malnutrition(GAM), Severe Acute Malnutrition(SAM), as well as crude and under-fivedeath rates between emergency andmonitoring surveys, a general summaryof the findings will be presented.

The levels of malnutrition differed signif-icantly across the 25 woredas in the fiveregions with GAM ranging from 2.7 per-cent in Arbaminch to 16.4 percent inShededino woredas of SNNPR. SAMprevalence was generally low. 16(64.0%) out of the 25 surveys had SAMlevels below 1 percent. The remaining 9surveys had SAM prevalence rangingfrom 1.0 to 2.1 percent.

Classification of the severity of the nutri-tion situation in the 25 woredas wasdone according to the Ethiopian nationalguideline for emergency nutritionassessment3. About one third (36%) ofthe 25 surveys were classified as seri-ous; 40 percent as poor and 24 percentas typical in the Ethiopian context.Regional wise, two of the three monitor-ing surveys conducted in Oromia wereclassified as serious and recommenda-tions were to continue with emergencynutrition interventions in the woredas. InSNNPR, the situation was a bit mixedwith, typical, poor and serious situations(see Table 2) Three of the four surveysconducted in Tigray were classified aspoor (see Table 3) indicating a need forclose monitoring of how the situationwas evolving.

It is important to note that 5 of the 7 sur-veys conducted in SNNPR and Oromiaregions in March 2009, were classifiedas serious. These results may signal twosituations. First, the improvement innutrition situation observed in the 4thquarter 2008 and the first two months of

the first quarter of 2009 was reaching aturning point in the surveyed woredasand others with similar characteristics.Second, close monitoring (April andMay) is needed as we move toward thepeak of the hunger gap (June-September) in Belg and Meher depend-ent areas. Emergency nutrition inter-ventions (general food distribution, blan-ket supplementary feeding, TSF andTFP) have to be planned and imple-mented in timely manner wheneverappropriate to mitigate the likely risk ofnutrition crisis and avoid the 2008 expe-rience.

Due to lack of nutrition surveillance inEthiopia and the fact that rarely surveysare conducted in the same area at thesame period of the year, it was difficult tocompare the 2008 and 2009 nutrition sit-uation during the first quarter of 2009. Ofthe 54 surveys conducted in 2008,ENCU identified two surveys only con-ducted by ACF in Coffee and EnsetLivelihoold zones in Sidama Zone inSNNPR, that were conducted in thesame areas and period of the year in2008 and 2009. The results were mixed.The coffee livelihood zone situation haddeteriorated from typical to poor and theEnset situation had improved from seri-ous to typical situation.

Death Rates: Crude Death Rate (CDR)from 25 surveys were below the emer-gency cut off points of 1/10000 popula-tion/day. Similarly, Under-Five DeathRates were also below national andsphere standard emergency thresholdlevel of 2/10000/day. Good performanceof the emergency and routineTherapeutic Feeding Programmes(TFP) in Ethiopia, partly explains the lowdeath rate reported in the nutrition sur-veys. These results are consistent withgenerally low death rate reported in TFPduring the same period (See Table 8).

3Guideline for Emergency Nutrition Surveys for Ethiopia, September 2008 or DPPC 2002.


Morbidity and immunization cover-age: Malaria, Diarrhoea and ARI werethe main causes of morbidity in all the 25surveys with variation from one woredato another ranging from 11.2 in Ambaselin Amhara to 41.2 percent in DamotPulassa woreda in SNNPR. Unlike theother four regions, malaria was as themajor cause of morbidity in SNNPRwhere it reached an outbreak levels.Reports from nutrition cluster partnersindicated that malaria outbreak in theregion contributed considerably to theincreased TFP admissions reported inthe first quarter. In Damot Pulassa forexample, malaria, diarrhoea and cough

altogether accounted for over 41 percentof the total morbidity in the woreda. Measles, BCG and Vitamin A coveragevaried significantly across the 25 sur-veyed woredas in the five regions.Vitamin A and measles coverage (cardand recall) in Tigray was impressive;where all four surveys (Table 2-3) hadlevels well above the 95 percent spherestandard cut off points in emergency sit-uation.

Majority of the woredas in the remainingregions had levels below the spherestandards. Details of the survey resultsare summarised in Table 2-3.

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Table 2a: Survey results in SNNPR against key indicators

SIDAMA ZONE

GAMOGOFA ZONE

K/T ZONE

Alaba Specia l Woreda

SILTE ZONE HADYA ZONE

Key indicators ELZ 18-25 Jan

CLZ 27 Jan.-01 Feb

Shebedino woreda 13-21 Mar

Arbaminch zuria woreda 20-31 Jan

K/Gamella woreda 6-11 Feb

Alaba Specia l Woreda 6-13 Feb

Sankura woreda 6-12 Feb

Shashego woreda 30 Jan-5 Feb

Survey design 50 clusters, 808 children

38 clusters, 696 children



35 clusters 702 children




% GAM in Z-scores (95% CI)

6.3 (4.4 -8.2)

8.9 (6.7-11.1)

16.4 (12.5-20.2)

2.7 (1.5-3.9)

4.0 (2.3-5.6)

7.3 (5.0-9.6)

7.7 (5.7-9.7)

6.8 (4.5-9.1)

% SAM Z-scores (95% CI)

0.4 (0.0-0.8)

0.6 (0.0-1.1)

1.6 (0.7-2.4)

0.3 (0.0-0.7)

0.4 (0.0-0.9)

0.4 (0.0-0.9)

0.4 (0.0-0.8) 0

% Kwashiorkor 0 0.4 0.3 0 0 0 0 0

CDR Death/10,000/day (95% CI)

0.04 (0.0-0.11)

0.19 (0.04-0.33)

0.15 (0.00-0.29)

0.08 (0.00-0.21)

0.17 (0.02-0.32)

0.38 (0.15-0.61)

0.33 (0.14-0.53)

0.18 (0.00-0.36)

U5DR Death//10,000/day (95% CI) 0

0.35 (0.00-0.91)

0.49 (0.01-0.99)

0.15 (0.00-0.36)

0.23 (0.00-0.63)

1.00 (0.11-1.90)

0.79 (0.15-1.42)

0.20 (0.00-0.57)

Major causes of U5DR NA NR NR Unknown NR Malaria

Neonatal death &

Diarrhoea Malaria

% Morbidity 21.8 17.1 33.1 15.5 23.5 36.3 37.7 14.9

Major illnesses or symptoms

Cough & Diarrhoea

Cough & Diarrhoea

Diarrhoea & Cough

Cough & Diarrhoea

Malaria, ARI &

Diarrhoea

Malaria, ARI &

Diarrhoea

Malaria, ARI &

Diarrhoea

Malaria , ARI &

Diarrhoea % Measles coverage by card (95% CI)

16.1 (12.7-20.3)

19.1 (15.1-23.8)

7.1 (4.7-10.5)

51.8 (44.2-59.5)

39.2 (34.0-44.7)

20.6 (16.6-25.3)

2.7 (1.3-5.1)

11.0 (5.7-17.0)

% Measles coverage by card + recall (95% CI)

85.3 (81.3-88.6)

92.7 (89.2-95.2)

68.9 (57.9-78.1)

92.8 (90.3-95.3)

95.1 (92.1-97.1)

90.3 (86.6-93.1)

87.2 (83.2-90.4)

70.2 (61.4-79.0)

% BCG coverage (scar) (95% CI)

56.8 (51.8-61.7)

59.1 (53.8-64.3)

45.4 (38.1-52.9)

65.8 (59.5-72.2)

75.8 (70.9-80.1)

74.8 (70.0-79.1)

66.1 (61.0-70.8)

46.1 (CI: NR)

% Vitamin A in past 6 months (95% CI)

82.7 (78.5-86.2)

85.5 (81.2-88.9)

68.6 (57.8-77.8)

93.4 (88.5-98.4)

94.0 (90.9-96.2)

88.6 (85.0-91.7)

83.6 (79.4-87.1)

68.8 (61.6-75.9)

classification of the situation

The situation was normal

poor with aggravating f actors of poor coffee harvest

Serious with very late onset & poor amount of belg rain

The situa tion was normal

The situation was normal

poor poor and food security deterioration remained a concern

Typical for a chronically food in secured community


Table 2b: Survey results in SNNPR, Oromia & Beneshangul Gumuz against key indicators

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SNNPR OROMIA B/GUMUZ

HADIYA ZONE WOLAYTA ZONE GEDIO ZONE WEST

HARARGHE ZONE

EAST HARARGHE ZONE ASSOSSA ZONE

Key indicators Soro woreda

9-14 Feb Damot Gale

woreda 23-29 Mar

Damot Pu lasa woreda

7 -17 Apr

Bu le woreda 18-28 Feb

Gedeb woreda 16-28 Feb

Kun i woreda 22-30 Mar

Kombolcha woreda, 11-21

March

Kersa woreda, 27 March

Kumruk woreda, 23 Jan-03 Feb.

Survey design 131 clusters, 524 children










12.4 (8.9-16.0)

9.6 (6.9-12.3)

11.0 (8.5-13.5)

7.1 (4.9-9.2)

10.5 (7.8-13.2)

11.2 (8.2-14.3)

10.8 (8.3-13.3)

12.8 (9.7-15.9)

13.2 (10.2-16.1)


1.0 (0.2-1.7)

0.7 (0.2-1.3)

2.1 (0.8-3.3)

0.3 (0.0-0.7)

2.1 (1.1-3.1)

1.6 (0.7-2.4)

1.0 (0.0-2.0)

1.5 (0.6-2.3)

1.9 (1.0-2.9)

% Kwashiorkor 0 0.1 0.9 0.1 0 0.2 0.6 0.6 0.4

CDR Death/10,000/day (95% CI)

0.28 (0.11-0.46)

0.23 (0.05-0.41)

0.08 (0.00-0.18)

0.22 (0.12-0.58)

0.24 (0.01-0.46)

0.24 (0.06-0.42)

0.15 (0.00-0.33)

0.13 (0.01-0.25)

0.30 (0.07-0.54)

U5DR Death//10,00/ day (95% CI)

0.75 (0.00-1.52)

1.22 (0.26-2.18)

0.77 (0.06-1.47)

0.23 (0.09-0.35)

0.13 (0.00-0.35)

0.47 (0.00-1.09)

0.59 (0.00-1.39)

0.31 (0.00-0.70)

1.13 (0.12-2.14)

Major causes of U5 deaths

Malaria & typhoid NR

Diarrhoea and body swelling NR Unknown Unknown Accident ARI NR

% Morbidity 18.9 36.5 41.2 18.0 13.6 21.7 27.4 19.8 24.7


Malaria, ARI &

Diarrhoea

Malaria, ARI &

Diarrhoea

Malaria, ARI &

Diarrhoea

Diarrhoea &

Cough

Diarrhoea &

Cough

Diarrhoea &

Cough

Diarrhoea &

Cough

Diarrhoea &

Cough

Diarrhoea &

Cough

% Measles coverage by card (95% CI)

16.5 (9.8-23.2)

14.8 (11.3-19.2)

12.4 (9.1-15.8)

5.0 (2.8-8.5)

6.0 (3.8-8.2)

6.0 (3.0-9.1)

7.7 (4.1-11.3)

12.9 (9.3-16.7)

7.4 (2.1-12.7)


64.3 (54.5-74.0)

64.2 (57.3-70.6)

87.8 (76.2-89.4)

62.1 (54.1-69.4)

31.9 (22.6-41.2)

59.3 (50.4-68.2)

72.2 (65.9-78.4)

64.2 (55.3-79.2)

86.7 (79.4-94.0)


46.0 (38.7-53.3)

64.8 (58.8-70.4)

62.8 (57.8-67.8)

41.1 (35.2-47.3)

31.5 (24.6-38.4)

38.8 (32.0-45.5)

53.3 (49.0-57.6)

49.7 (42.5-56.9)

51.0 (43.1-59.0)


71.2 (63.1-79.2)

92.0 (88.3-94.7)

93.9 (90.2-97.7)

76.9 (69.4-83.0)

60.2 (51.5-69.0)

54.0 (43.8-64.2)

60.2 (50.6-69.7)

83.6 (75.3-91.9)

92.5 (89.2-95.8)

Classification of the situation

Serious with aggravating factor of poor meher harvest

Poor with aggravating factor of high incidence of malaria

Serious with poor prospect of sweet potato harvest due to failure of sape rain and poor performance of belg rain

Poor with aggravating factor of poor food availability due to coffee production failure

Serious with aggravating factor of poor food availability due to coffee production failure

Serious with aggravating factor of food shortage in lowland areas

Poor, food security was okay but needs close monitoring as hunger period was approaching

Serious with poor meher harvest

Serious The food security was okay but some communities needed food assistance due to internal conflict displacement

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Table 3: Survey results in Amhara & Tigray regions against key indicators

Somali Standard Nutrition Surveys: InFebruary 2008, the government in collab-oration with partners agreed to conductstandard nutrition assessments in theSomali region under the coordination andleadership of the Ethiopian Health andNutrition Research Institute (EHNRI). Anational steering committee co-chaired byEHNRI and UNICEF was formed as wellas a technical team spearheaded by theENCU. Similar technical team was formedat Somali region level.

The federal technical team visited Somaliregion twice during the planning stage anddiscussed with regional counterparts onthe planning and preparations of the sur-veys. In order to have a fair representationof the nutrition situation in the region, it

was agreed to conduct the surveysbased on livelihood zones. There were17 livelihoods in the region which in turnwere consolidated into 11 mega liveli-hoods. Seven surveys representingseven different livelihood zones wereproposed by the regional authorities andagreed by the federal steering commit-tee. The selection of the livelihoodszones and woredas to be surveyed con-sidered the following factors: accessibil-ity, security, logistics, availability ofhuman and financial resources etc. Thefederal technical teams prepared thesurvey proposal, manual, tools, equip-ments and logistics. All these were dis-cussed and agreed with the regionaltechnical team.

Because of the number of surveys

AMHARA

NORTH SHEWA ZONE SOUTH WOLLO

NORTH WOLLO

TIGRAY

Key ind icators Eferata woreda 22 Jan 02 Feb

Menz Gera woreda 23-29 Jan

Tenta woreda 22-27 Jan

Ambassel woreda 14-22 Mar

Kilte Awula lo woreda 26-31 January

SasiTsaeda Amba woreda 27 Jan.-01 Feb

Atsbi Wonberta woreda 26-31 Jan

Alamata woreda 26-30 Jan

Survey design



32 cluste rs, 644 children

40 cluste rs, 437 children






5.1 (3.3-6.9)

8.1 (6.0-10.2)

12.7 (9.6-15.8)

11.4 (8.5-14.4)

5.0 (3.3-6.8)

6.3 (4.4-8.3)

2.8 (1.6-3.9)

5.0 (3.3-6.6)


0.4 (0.0-0.8)

0.6 (0.0-1.3)

1.2 (0.3-2.2)

0.9 (0.1-1.7)

0.6 (0.1-1.1)

0.3 (0.0-0.7)

0.1 (0.0-0.3)

0.5 (0.0-1.1)

% Kwashiorkor 0 0 0 0 0.1 0 0.1 0 CDR Death/10,000/day (95% CI)

0.34 (0.17-0.52)

0.27 (0.07-0.47)

0.05 (0.00-0.15)

0.22 (0.03-0.41)

0.18 (0.05-0.31)

0.11 (0.01-0.22)

0.22 (0.07-0.36)

0.19 (0.06-0.63)

U5DR Death//10,000/day (95% CI)

0.45 (0.00-0.97)

0.42 (0.00-0.91)

0.27 (0.00-0.63)

0.78 (0.00-2.57)

0.30 (0.00-0.63)

0.60 (0.45-1.66)

0.99 (0.24-1.14)

0.44 (0.11-1.78)

Major causes of U5MR

Ari & Diarrhoea

Pneumonia & Diarrhoea Unknown Diarrhoea Unknown Unknown Unknown Unknown

% Morbidity 16.6 27 11.8 11.2 27.6 1.9 21.3 26.5


Ari & Diarrhoea

ARI & Diarrhoea

Diarrhoea & ARI

Diarrhoea & ARI Cough

No major illness Cough Diarrhoea

% Measles coverage by card (95% CI)

60.7 (55.1-65.3)

82.5 (78.2-86.1)

26.9 (22.2-32.3)

18.9 (14.7-23.1)

82.4 (76.2-88.7)

95.7 (92.7-97.5)

83.7 (76.6-90.9)

39.6 (29.2-50.0)


97.9 (95.3-98.8)

92.4 (89.2-94.2)

89.4 (85.3-92.5)

87.5 (82.2-92.7)

97.3 (95.5-99.2)

100 (98.6-100.0)

98.8 (97.5-100.1)

96.4 (94.5-98.2)


96.2 (93.6-97.8)

86.8 (82.9-89.9)

50.6 (45.0-56.2)

47.4 (41.5-53.3)

97.8 (96.2-99.3)

99.7 (97.9-99.9)

84.9 (78.3-91.5)

71.4 (64.8-78.0)


97.8 (95.6-98.9)

98.3 (96.3-99.3)

96.7 (94.0-98.3)

93.1 (89.8-96.5)

94.1 (90.9-97.2)

99.9 (98.4-100.0)

98.6 (97.8-99.5)

94.7 (90.2-99.1)

Classification of the situation

Typical with poor harvest due to untimely rainfall

Poor with aggravating factors of poor harvest to frost attack

Serious with aggravating factors of poor harvest

Serious with aggravating factors of poor harvest, insufficient belg rain followed by hunger gap period (March May

poor with aggravating factors of poor harvest, pasture and livestock


Typical for a chronically food insecure community with aggravating factors of poor harvest, pasture/ livestock


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involved, considerable resources interms of human, financial, logistics andequipments were needed. In monetaryterms the seven surveys were estimatedto cost about US$458,337. Nutritioncluster partners4 contributed either inkind and/ or financial. Large part of theassessment budget (71.2%) was fundedby DFID through the HRF fund man-aged by UN OCHA. The actual imple-mentation of the survey was planned tocommence from 3rd week of April to 2ndweek of May 2009. Preliminary resultswere expected by 3rd-4th week of May2009.

Hotspot woredas: ENCU in collaborationwith partners reviewed the list of thehotspot woredas by updating the 2008fourth quarter hotspot list. By mid March2009 revised list of 151 hotspot woredaswas shared with nutrition cluster partnersand other stakeholders. Compared to thefourth quarter of 2008, the number ofhotspot woredas had decreased by 30percent from 216 in 2008 to 151 March2009. Distribution of the number ofhotspot woredas across the country is pre-sented in Table 4 below.

Criteria used during the hotspot classifi-cation process included: levels of mal-nutrition, food security situation, TFPadmissions, stress condition, migrationetc. The classification process was doneat two levels, at regional and federal.The regional level classification wasreviewed at federal level and where nec-essary was considered during the overallprioritization of the woredas. It has to benoted, however, that classification usedat both regional and federal was a bitsubjective and DMFSS and partnersstressed for the finalization of the IPC5

classification system so as to standard-ize the process and criteria across thecountry. A special task force composedof members from ENCU, WFP, DMFSS,FAO, SC UK, CARE started working onthe IPC system/approach. Meaningfulcomparison of the 2008 and 2009 situa-tion using changes in number of hotspotworedas could not be made becauseprioritization was not done in threeregions (Tigray, Amhara and Afar), thatexperienced nutrition emergency in2008.

4Partners that contributed to the Somali survey included: SC UK, ACF, SC US, Merlin,Mercy Corps, Samaritan Purse, MSF Belgium, MSF Holland, UNICEF, WFP, WHO.

5Integrated Phase Classification.

Table 4: Distribution of the hotspot woredas by mid March2009 in Ethiopia

Region Priority 1

Priority 2

Priority 3

Total

Tigray 12 11 8 31

Afar 11 5 7 23

Amhara 35 11 3 49

Oromia 44 23 3 70

Somali 14 13 26 53

Beneshangul Gumuz 2 3 0 5

SNNPR 33 29 2 64

Gambella 0 9 0 9

Dire Dawa 0 1 0 1

Total 151 105 49 305

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1.3 ENCU DATA BASES

Surveys whose quality has beenchecked, accepted and reportsendorsed by the EWRD are stored in theENCU nutrition survey data base. Thedata base is posted on the ENCU webpage of the DPPC website:www.dppc.gov.et/pages/ENCU.htm andcan be accessible by interested users inand outside the country. By the end ofthe first quarter 2009, the data base hada total of 534 records. Most of the sur-veys are either emergency surveys con-ducted to ascertain nutrition situationand plan for emergency response ormonitoring surveys following nutritioninterventions. These surveys were con-ducted at different period of the year.They were not conducted for surveil-lance purposes as such though somecould provide useful trends. Table 5summarises the distribution of the sur-veys conducted in the various regions inEthiopia in the last 10 years.

For the first time in the last 10 years anemergency survey was conducted in

Beneshangul Gumuz region (Table 5)and a formal request for conductingstandard nutrition assessment in thearea was submitted to theDMFSS/ENCU by the Gambella region-al authorities. If conducted, that wouldbe the first standard nutrition assess-ment in the region. Gambella andBeneshangul regions are usually notprone to emergency nutrition crisisexperienced in other regions in Ethiopia.This could partly explain lack of stan-dard nutrition assessments in the tworegions.

Other nutrition information that is updat-ed regularly include: TFP, EnhancedOutreach Strategy (EOS) ProductiveSafety Net Programme (PSNP),Targeted Supplementary FeedingProgramme (TSFP) and EmergencyFood Relief. This information are notposted on the ENCU webpage and canonly be accessible with permission fromthe EWRD/DMFSS.

Table 5: Number of nutrition surveys conducted per region per year since2000.

Year Region 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Total SNNPR 9 5 35 30 14 25 20 16 36 13 203 Oromia 3 2 20 27 22 20 14 6 9 3 126 Amhara 5 9 24 17 9 7 6 4 8 4 93 Somali 8 5 5 5 8 11 12 2 0 0 56 Tigray 0 0 6 7 3 3 0 8 0 4 31 Afar 0 0 4 5 1 6 4 2 1 0 23 Gambella 0 0 0 0 0 0 0 0 0 0 0 B/Gumuz 0 0 0 0 0 0 0 0 0 1 1 Harare 0 0 0 0 0 0 0 1 0 0 1

Total 25 21 94 91 57 72 56 39 54 25 534

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2.1 NEW ADMISSIONS IN TFP(THERAPEUTIC FEEDING PROGRAMME)

The TFP admissions is influenced byfood access and intake, access to andutilization of health care, personal andenvironmental hygiene, infant andyoung child practices, coverage of TFPand supplementary feeding pro-grammes (classic and TSF), quality ofTFP services. Overall a total of 23,749severely malnourished children wereadmitted in 550 (40.1 percent of the1372 TFP sites) TFP sites from January

to March 2009 from the six regions(SNNPR, Oromia, Tigray, Amhara,Somali and Afar) vulnerable to nutritionemergencies in the Ethiopia. It shouldbe noted, however, that the below trendrepresents only the sites whose month-ly TFP reports were obtained during thereporting period and not the entire coun-try. There was a considerable increasein TFP admissions from February toMarch as shown in Figure 2 below.

Figure 2: Trends in TFP admissions and report completion rate (40%reporting sites) in Ethiopia, Jan - Mar 20096

6TFP admissions and reporting rate is continuously updated ondaily basis as reports are received from partners.

2. EMERGENCY NUTRITION INTERVENTIONS

This section provides brief account of the emergency nutrition interventions focusing onnew admissions, coverage and performance of Therapeutic Feeding Programme (TFP).

7,5097,160

9,099

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

Jan-09 Feb-09 Mar-09

Admission

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%Report completion

Admissi on % Report compl eti on

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However, there was a clear increasingtrend in TFP admission in severalworedas in SNNPR. Such woredasincluded: Boricha, Damboya, DamotGale, Damot Sorie East Badawacho,Loka Abaya etc. with reporting rate of 80percent and above. SNNPR with over38 percent of the TFP sites in the coun-try as of March 2009 had about 52.6 per-cent reporting rate. Similarly, TFPadmissions were increasing in someworedas in Somali region, particularly inDegahbur and Kelafo with 80 percentand above reporting rate.

The increasing admissions trends inSNNPR (Fig 3) was partly becausecoffee dependant woredas of Sidamaand Gedeo zones could not recoverfrom the 2008 nutrition crisis due toabout 60 percent coffee production fail-ure. These areas continued experienc-ing increased admissions in TFPthroughout the first quarter of 2009.Household food insecurity in otherzones like Wolayita also contributed tothe overall increasing TFP admission

trend at regional level. Because of lowreporting rate in Oromia region, it wasdifficult to deduce a meaningful trend.However, the total number of TFPadmissions were likely to be highergiven that West Arsi , East and WestHararghe zones, despite reports ofincreased admissions in TFP sites, theirJan - Mar reports were not submitted tothe ENCU. Admissions in other regions(Amhara and Tigray) were relativelystable with some few areas reportingincreased admissions.

Direct comparison of new admissionsbetween 2008 and 2009 was not mean-ingful because of one major reason. Thenumber of TFP sites in the first quarterof 2009 is about four times the numberthat existed in the same period in 2008.Thus, direct comparison could be mis-leading in the sense that numericalincrease in 2009 may not imply that thesituation is worse than 2008 but rathermay reflect increased TFP servicecoverage.

Figure 3: Increasing TFP admissions in SNNPR's TFP reporting sites (52.6 %reporting rate), Jan - Mar 2009

2,621

3,198

4,651

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

Jan-09 Feb-09 Mar-09

Admission

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0% Report completion

Admi ssion % Report compl eti on

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2.2 COVERAGE OF EMERGENCY INTERVEN-TIONS IN HOTSPOT WOREDAS

Despite the decrease in the number ofthe hotspot woredas compared to thefourth quarter, coverage of the emer-gency nutrition interventions remainedrelatively the same. This was partlybecause, there were new woredas thatwere defined as a hotspot for the firsttime which by then were not covered bynutrition interventions. There was aslight increase in the coverage of theworedas with comprehensive interven-tions (TFP+TSF/SFP) from 46 (fourthquarter) percent to 49.0 percent by theend of the first quarter. Overall, about 80percent of the hotspot woredas had atleast one emergency nutrition interven-tion. Coverage of nutrition interventionsin the hotspot woredas is shown inTable 6.

ENCU as the nutrition cluster coordinat-ing unit continued advocating forexpanding emergency nutrition in priori-ty number one woredas throughMANTF/ cluster meetings and the HRFmeetings. As it was in 2008, HRF con-tinued supporting nutrition related inter-ventions in the country. During the firstquarter, a total of 7 related nutrition proj-ects were funded by HRF. Before thenutrition projects were funded by theHRF, the proposals for emergency nutri-tion interventions were reviewed by thenutrition cluster and recommendationswere made to the HRF to either fund ornot depending on the quality of the pro-posal and technical capacities of theapplying partners.

Table 6: Coverage of emergency nutrition interventions in hotspot woredas inEthiopia Jan - Mar 2009

* In brackets are percentages.

A total of 456 RUTF metric tons were distributed by UNICEF to different parts in thecountry for both routine and emergency nutrition interventions. The amount distributedwas part of the RUTF procured in the 2008. Meanwhile, a total of 775 metric tons ofRUTF were in the pipeline.

2.3 SUPPLIES

Region # hotspot woredas TFP + EOS/TSF and/ or SFP (%)*

TFP but No SFP or EOS/TS (%)

EOS/TSF but No TFP (%)

No TFP No EOS/ TSF No SFP (%)

SNNPR 33 21 (63.6) 4 (12.1) - 8 (24.4)-

Tigray 12 12 (100) - - -

Oromia 44 8 (18.2) 18 (40.9) 3 (6.8) 15 (34.1)

Amhara 35 19 (54.3) 5 (14.3) 10 (28.6) 1 (2.8)

Somali 14 11 (78.6) 2 (14.4) 1 (7.1) -

Afar 11 3 (18.2) 1 (9.1) 3 (27.3) 4 (45.5)

B/Gumuz 2 - 1 (50.0) - 1 (50.0)

Overall 151 74 (49.0) 31 (20.5) 17 (11.3) 29 (19.2)

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2.4 PERFORMANCE OF THERAPEUTIC FEEDINGPROGRAMMES (TFP) IN ETHIOPIA, JAN - MAR 2009

The quality of the emergency and non-emergency nutrition interventions ispartly determined by the level of per-formance indicators compared againstthe national and sphere standards.Based on the received reports in thereporting period, performance indicatorsof the emergency nutrition interventionswere well above the national andSphere Standard cut off points com-pared to the last two quarters of 2008.Recovery rate increased by 6.5 percentfrom 77 to 81.8 percent in the fourth andfirst quarters of 2008 and 2009, respec-tively. Defaulter rate, one of the notori-ous indicators suspected to have beenaffecting the overall recovery rate in theprevious quarters of 2008 decreased aswell from 5 to 3.6 percent. Selected per-formance indicators as recommendedby the national guideline and SphereStandards is shown in Table 7.

The challenge is if the first quarterattained performance levels will bemaintained and improved in the comingquarters of 2009.

Despite that, the overall performanceindicators were above the National andSphere Standards, recovery rates werestill below the recommended cut offpoints in Tigray and Somali regions.Accessibility challenges in some part ofSomali region could partly explain con-siderable proportions in "other rates"and therefore low recovery rate. ForTigray, the reason is likely to be due tohigher medical transfers, non-respon-dent and transfer outs. Follow up willbe made in collaboration with Tigrayregional Health Bureau to find out thereasons behind consistent relativelyhigher defaulter and other rates.

Table 7: Performance of emergency and non-emergency TFP interventions inEthiopia based on monthly reports Jan- March 2009

*In brackets are percentages.**Other rates refer to medical transfers, non-respondent and transfer out.

2.5 TARGETED SUPPLEMENTARY FOOD (TSF)

During the first quarter, WFP in collaboration with the government distributed TargetedSupplementary Food (TSF) to 293,557 under-five children, pregnant and lactatingwomen in six regions as part of the EOS/TSF programme implemented by Governmentof Ethiopia. It was not possible to have distributions in Afar in this quarter due to foodresource constraints. Table 8 summarizes the amount of food distributed and respec-tive beneficiaries in the six regions. Currently WFP is supporting 166 TSF woredas. Of151 March 2009 hotspot list Priority one, 124 (82%) were covered by TSF programmeduring this quarter.

Region Total admissions

(n)

Reporting Rate (%)*

Total d ischarge

(n)

Recovery/ Cure Rate (NS>75%)

Death Rate

(NS<5%)

Defaulter Rate

NS<15%)

Other Rates (%)

Amhara 1610 48.6% 1406 81.2% 1.8% 5.5%

11.5

Oromia 4027 21.6% 3551 87.1% 0.3% 1.1%

11.5

SNNPR 10470 52.6% 9795 85.1% 0.5% 1.8%

12.6

Somali 4330 31.3% 3688 72.2% 0.3% 7.7%

19.8

Tigray 2221 63.6% 2048 68.8% 0.5% 9.1%

21.6

Afar 1091 66.7% 775 96.8% 3.2% 0.0%

100

Total 23,749 40.1% 21,263 81.8% 0.6% 3.6% 14.0

**

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Table 8: Regular TSF distributions Jan - Mar 2009 in six regions

Beneficiaries Region

Dispatched food (MT)

Total beneficiaries Under-five Pregnant and

Lactating women

Amhara 997.332 35,803 24,346 11,457

Gambella 86.440 3,103 2,110 993

Oromiya 1,313.110 47,139 32,055 15,084

SNNPR 2,543.598 91,312 62,092 29,220

Somali 2,361.828 84,787 57,655 27,132

Tigray 875.049 31,413 21,361 10,052

Total 8,177.357 293,557 199,619 93,938

Meanwhile, results from the first threemonths of data collection under the TSF2008 outcome evaluation study conduct-ed by WFP were presented to a variousstakeholders. The main conclusion asregards to TSF effectiveness was thatTSF had a statistically significant nutri-tional benefits for the children enrolledinto the programme. However, the effec-tiveness of TSF was hampered by twomain factors: 1) EOS7 screening inclu-sion errors were found to be 46 percent(by MUAC) or 63 percent (by W/H z-score). The report also indicated thatacutely moderately malnourished chil-dren responded well to TSF providedthan well nourished children wronglyenrolled into the TSF programme.

2) Widely spread food sharing in thehouseholds of the enrolled children inthe TSF. This was evident even duringthe study period where several otherfamily members shared TSF food thatwas meant for the moderately malnour-ished children. This practice slows downthe recovery and other intended effecton the malnourished child.

The report recommended that 1) EOSscreening should be improved to ensureappropriate targeting into TSF and 2)Food sharing needs to be studied furtherand addressed by programme design.The final report reflecting 6-months datacollection and analysis would be avail-able in June 2009.

2.6 EMERGENCY NUTRITION INTERVENTION CHALL-ENGES

1) Low TFP monthly reporting rate espe-cially from TFP sites under the directmanagement of the local authoritiesacross the country except in Tigrayregion. TFP data base at ENCU showthat 85 percent of the monthly TFPreports received during the first quarterwere submitted by NGOs implementingnutrition interventions. Despite the cur-rent low reporting rate (40%), is twotimes higher, compared to 2008 where itwas below 20% at this time of the year.2) Low coverage of TFP interventionswithin hotspot woredas and hence notreaching all the vulnerable children.Through the Heath ExtensionProgramme (HEP) the FMOH with sup-port from UNICEF and other partners,significantly expanded provision of TFP

services in the country. The number ofTFP sites has increased almost fourtimes compared to same period in 2008.However, more TFP (both OTP andTFU) sites are still needed so as to bringthe services closer to the beneficiariesand reach many more eligible childrenand other vulnerable groups. 3) Limitedpartners' capacities to expand to emerg-ing new hotspot woredas. 4) Limitedaccessibility to intervention areas due tosecurity challenges especially in someparts of Somali region that impairedmonitoring and follow up of childrenadmitted in TFP sites. 5) Lack of sup-plementary feeding programme in someof hotspot woredas with TFP interven-tions (see Table 6 above).

7The Enhanced Outreach Strategy (EOS) is implemented by the Government supported byUNICEF.

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3. ESTIMATED TFP BENEFICIARIES AS PART OF THE JAN -JUN 2009 HUMANITARIAN APPEAL

The projected number of children to beadmitted in TFP is the basis for planningand allocation of resources by theGovernment and partners. Since, nutri-tion assessments were not conductedalong with the needs assessments, sec-ondary data analysis was conductedusing the year 2000 (provided by theEthiopian Meteorological Department)as analogous for the 2009. The Jan-JunTFP beneficiaries were estimated basedon the 2008 Meher Needs Assessments.According the final report8 , estimatedbeneficiaries in PSNP and the emer-gency needy population was 11.8 mil-lion. A maximum of 2.0 percent SAMprevalence (analogous to 2000) andunder-five population was estimated at14.5 percent of the total rural populationin the affected woredas was used toestimate total beneficiaries in TFP.

Putting the above factors into the equa-tion, the total TFP beneficiaries from Jan- Jun 2009 were estimated at 34, 379.

This estimate is likely to have underesti-mated the total TFP beneficiaries in the309 woredas that needed humanitarianfood assistance during the referenceperiod. This is because during the firstthree months (Jan -Mar) of 2009, a totalof 23, 749 (69.1% of 34,379) (Table 7)had already been admitted in TFP sitesin six regions; SNNPR, Amhara, Tigray,Oromia, Somali and Afar. ENCU esti-mated that if the TFP estimate wouldhave been based on the overall totalrural population covered by the needsassessment using similar assumptionsexplained above, the plausible estimat-ed of the TFP beneficiaries Jan-Jun2009, would have been around 87,696.

8Needs Assessment report January to June, 2009.9Fourth Quarterly Emergency Nutrition Bulletin, December 2008.

4. RETROSPECTIVE STUDY ON NON-ANTHROPOMETRICDATA BASED ON NUTRITION SURVEYS CONDUCTEDIN ETHIOPIA. (2000-2008)

As briefly explained in the 2008 4thquarterly emergency nutrition bulletin,the above mentioned study is conductedby Nutrition Works a partnership of inter-national nutritionist based in London.The study is conducted in collaborationwith the ENCU, UNICEF and GOALEthiopia. The objectives of the studywere explained in the 2008 ENCU fourthquarterly bulletin9 , however, for a quickreference, they are recited below 1) Toevaluate the methods, data and indica-tors of non-anthropometric variables col-lected in nutrition surveys conducted inEthiopia. 2) To evaluate the quality ofthe methods and data reported in rela-tion to ENCU (government) guidelines.3) To evaluate the conclusions and rec-ommendations made from the data.4) To examine the use made by agen-cies or programmes of the survey datacollected.

In order to address the fourth objectiveabove, two staff from the Nutrition Works

conducted a key informant interviewwith nutrition cluster partners responsi-ble for designing and conducting nutri-tion assessments and decision makers,donors, representatives of governmentdepartments in Addis Ababa and in tworegions, SNNPR and Amhara in early tomid February, 2009. Findings of thestudy will be shared to all partners andstakeholders in a feedback workshopthat will be organized by the ENCU incollaboration with GOAL and NutritionWorks in June or early July 2009.Partners would be informed of the dateand venue later. Recommendation andconsensus on collection and use of con-textual data will be shared with theEWRD for approval after which will beincorporated in the interim guideline foremergency nutrition surveys in Ethiopia(September 2008). The study is fundedby Global Nutrition Cluster and the UNOCHA Ethiopia Humanitarian ReliefFund (HRF).

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5. WORKSHOP ON NUTRITION ASSESSMENTMETHODOLOGY IN PASTORALISTCOMMUNITIES IN ETHIOPIA

ACF France in Ethiopia, in collaborationwith the ENCU organized a workshop onPastoralist Nutrition Survey in Ethiopiafrom 5-6th March 2009 and officiated bythe Director for Early Warning andResponse Directorate of the DMFSS.The objective of the workshop was toshare experiences of the findings of thepilot study in Mali and explores the pos-sibility of conducting similar pilot studiesin the Ethiopian context.

Several technical issues around the pro-posed Pastoralist Survey Methodologywere discussed. These included: valida-tion of the qualitative and quantitativedata; sampling unit; training require-ments; scope of the assessment (col-lecting non-anthropometric data); casedefinition of acute malnutrition (use ofMUAC versus Weight for Height); sam-ple size etc. Further discussions onthese issues were still needed. Therewas general consensus, however, onthe need for piloting the PastoralistSurvey Methods in Ethiopia using aDevelopment Surveys approach of See

one, Do one and Teach one. A TechnicalImplementation Group for Ethiopia Rollout (TIGER) comprising ACF, ENCU,SC-US/SC-UK, EHNRI and the EWRDwould be formed. TIGER would beresponsible for conducting the develop-mental surveys.

The need for the developing surveymethods for pastoralist communities isgrounded on the fact that over the yearsthere have been challenges in using thestandard nutrition assessment methodsin pastoralist areas as well as interpreta-tion of the survey findings. The develop-ment surveys findings will enrich andimprove chapter 8 of the national interimguideline on emergency nutritionassessments for Ethiopia (September2008 edition). The workshop wasattended by participants from nutritioncluster partners both national and inter-national NGOs, UN agencies, EWRDand FMOH/EHNRI and facilitated byMark Myatt, Anne-Marie and ACFFrance (Ethiopia).

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